Saturday, December 21, 2013

noun1. the action of being rescued or set free. synonyms: liberation, release, delivery.

It never fails. Glen and I will be on our stroll through the grocery store- toddler in the cart and the 2 middles trailing behind, the 6 year old undoubtably asking if he can get an "example" from the cheese section, and the 8 year old complaining of the mundane boringness that is the grocery store.

As we walk the aisles, me having hot flashes and trying my best to not have a meltdown as I am trying to multitask with maintaining my thought process, have a coherent 'what do you want for dinner?' conversation with the husband and create dialogue with the children as to make this wonderful trip a well-rounded, learning adventure (ee-gads!), we run into a familiar face. Glen smiles and says hello, then looks at me and lets me know (as if I don't already know...), "I delivered her." It is doctor-speak at it's finest.

'I delivered her.' Delivered her? Delivered her of what, exactly? Are you Catholic? (Oh wait, yes you are.) Are you a priest? (I did indeed ask him this once. He rolled his eyes at me.) Delivered the baby? Then what did she, the woman, do? She did indeed deliver her baby, did she not?

Glen acknowledged the point behind my dramatics. He asked what I thought was better verbiage. I said, "How about 'caught'?" He then asked- "What about a cesarean birth? Did I 'catch' that baby?" Ok. Fair enough.

Historically- at least in my own circle of midwives- I have noticed that many midwives use the phrase "caught." With that notion, I have delivered three babies in my life, but have caught many.

That phrase is very midwifery-like. And I like the notion of it- thoughtful, sensitive, acknowledging of the primary source of power and labor- the woman, not the midwife or doctor.
However, are we really just 'catching?' There has been a once or twice where the birth has been so precipitous that I have indeed been nothing more than loving, anticipating, welcoming hands. I have, quite literally, 'caught.' Mom shows up huffing and puffing- the majority of the hard work behind her- complete and pushing. No time for anything other than to catch a baby.

However, that's not the usual work of a midwife. To say that I do nothing more than 'catch' a baby is demeaning. And it's simply not accurate. I hold two lives under my responsibility and care. Monitoring vitals, heart tones, supporting, simply observing, not acting, but being prepared to act as necessary- should there be the need. THAT is a midwife, and then some. So I suppose my own verbiage of 'catching' is no better than 'delivered.'

Words are indeed powerful, and I am always ever so mindful of this. But whether it be 'catch' or 'deliver,' sometimes there is just no word that will do it full justice, in all respects.

Monday, December 9, 2013

In.te.grat.ed. The combination of separate elements to provide a harmonious, interrelated whole.

This definition speaks of us, as a doctor and a midwife who are indeed separate elements, who are each independent practitioners, holding different skillsets, knowledge, and experiences, having been trained in vastly varying environments. But, as different as our training may have been, and as contrasting as our individual styles may be (ha!), we do indeed harmoniously practice together (well, perhaps I lie. Harmoniously, not always. Sometimes the boxing gloves nearly come out...) coming to each other to consult, share knowledge, and learn equally from each other.

But what does that look like for a woman in our care? Patients usually choose one pathway- physician care or midwifery care. Some patients, on occasion, choose to do a blend of both.

Having individual clients allows us to give continuity of care, in a personalized way. I love having my "own" clients, as the relationship that develops between a midwife and the woman and her family is a cornerstone for birth. Understanding,Trust, Respect...which of course go both ways.

An interesting thing has been happening lately. More and more people are choosing to forego the hospital and they are choosing 'Out-Of-Hospital' birth. Our Out-Of-Hospital birth rate for the coming months has sky-rocketed. Planned birth center and home birth is at an all-time high for us (hmmm...I wonder why?).

With the rising percentage of our patients choosing OOH birth, another interesting thing has begun to happen- patients are asking if their births can be attended by Glen, in addition to myself. And honestly, I go back and forth between whether this is good or bad. On one hand, I'm offended. No seriously. It offends me. I have had more than one client request if Glen can be there...you know, 'just in case.' In a professional, pleasant, but very overt way, I've had to put it out there. A midwife is trained to, and capable of, functioning independently. A midwife specializes in normal birth. A midwife is trained to recognize abnormal and is skilled to intervene when needed and seek a higher level of care, when appropriate. Having a doctor in attendance does not guarantee you a good or better outcome. You are no safer having a doctor at your birth center birth than you are having a midwife attend your birth center birth. And further, let's remember that statistics show that low-risk, healthy women with low-risk, healthy pregnancies have just as good, if not better, outcomes compared to low-risk moms within the hospital, under the care of a doctor. So...again...on one hand it might be looked at as offensive to the midwifery profession or even myself as a midwife.

But, with my initial emotional feelings pushed aside, is there a positive to families desiring to have their Out-Of-Hospital birth attended by a physician?

Well yes, I suppose there is! Let's think about it: there is a vast demographic of women and their families who may not ever have considered delivering their baby outside of the hospital, who would have otherwise, without a second thought, delivered in the hospital setting (and therefore potentially encountered various restrictions and interventions that may not have been needed). If having a doctor attend their birth- so that they can have an unmedicated birth center waterbirth- opens the gateway for more families to feel comfortable choosing that, then one might argue, Why Not?